USE OF 3 ADDITIONAL MID-BIOPSIES TO IMPROVE LOCAL ASSESSMENT OF PROSTATE-CANCER IN PATIENTS WITH ONE POSITIVE SEXTANT BIOPSY

Objectives: Routine sextant biopsies have proven useful in the diagnos is and local staging of prostate cancer. A single positive biopsy is m ore frequently associated with a smaller tumor and a low risk of posit ive margins. Nevertheless, the risk of positive margins in patients wi th 1 positive sextant biopsy remains high (20 %). A better assessment of local invasion is therefore needed. In addition to standard sextant biopsies, we routinely obtain 3 additional mid biopsies from the apex to the base of the prostate. The aim of this study is to analyze the contribution of these 3 additional mid biopsies to local staging. Meth ods: From 1988 to 1996, 177 men underwent sextant biopsies plus 3 addi tional mid biopsies prior to radical prostatectomy; 59 men had I posit ive sextant biopsy, and 13 also had 1-3 positive mid biopsies. The pat hological results of the prostatectomy specimens from these 13 men (gr oup A) were compared with those of the 46 men with only 1 positive sex tant biopsy (group B), by means of the Fisher and Mann-Whitney tests. Results: The two groups were similar in terms of age, preoperative pro state-specific antigen, the Gleason score of positive biopsies, the we ight of the specimen, the Gleason specimen score, tumor volume and pat hological stage. Positive surgical margins were found in 53.8% of grou p A and 19.4% of group B patients (p = 0.002). The location of the pos itive additional biopsies matched that of the positive surgical margin s. Conclusions: Additional mid biopsies improve the local assessment o f prostate cancer in patients with a single positive sextant biopsy, i dentifying significantly more positive margins when these additional m id biopsies are positive and indicating the location of the positive s urgical margins. These informations could be helpful to avoid positive surgical margins during radical prostatectomy.